The title of Dr. Arwal’s lecture was “Community based health care services in Afghanistan” and in his enthusiastic presentation, Dr. Arwal described himself as a non-academic practical person working with public health issues in all his life. Afghanistan has been in conflicts for 35 years and one of the main challenges has been to re-build a health care system that is responsive to the health needs of the people.
It was not an easy task to organize a well-functioning primary health care system in a war-ridden country. At first the Department of community based health care was only me, a desk and a Chair, said Dr. Arwal.
Community involvement
Afghanistan’s healthcare system is built on, apart from its own traditions, contextual initiatives and experiences from other countries. This enabled them to address the problems of accessibility of health care services at all levels of care delivery and to improve the quality of care for the population. Even more importantly, they managed to achieve a high level of active community involvement and participation.
The service providers at the community level are namely volunteers selected by the community and they stay and serve their respective communities after a minimum of six weeks training.
Primary health care coverage
One of the greatest achievements includes the high level of family planning services which is up to 67% in his country today. Among the most important challenges are the continued battle with insecurity, the still all too high levels of illiteracy combined with limited female community health supervisors. There are also challenges tied to the lack of adequate secondary and tertiary health services which cover the whole population.
As the person responsible for primary health care coverage in Afghanistan Dr. Arwal is very proud that these achievements have taken place under such difficult conditions. This provides hope for the future development of community health care services in a country in deep crisis after more than three decades of war